From the Guidelines
Night terrors in adults with PTSD can be effectively managed through a combination of therapy and medication, with imagery rehearsal therapy and cognitive behavioral therapy for insomnia (CBT-I) being first-line approaches, as recommended by the American Academy of Sleep Medicine position paper 1. The causes of night terrors in adults with PTSD are complex and multifaceted, involving hyperarousal of the autonomic nervous system and the brain's attempt to process traumatic memories during sleep. Key factors contributing to night terrors include:
- Hyperarousal of the autonomic nervous system
- Brain remaining in a heightened state of alertness during sleep
- Fragmented sleep and intrusive nightmares as the brain processes traumatic memories For treatment, medications that may help include:
- Prazosin (starting at 1mg at bedtime, gradually increasing to 3-15mg as tolerated), which specifically targets nightmares by blocking norepinephrine receptors, as studied in several randomized controlled trials 1
- SSRIs like sertraline (50-200mg daily) or fluoxetine (20-80mg daily) can address underlying PTSD symptoms
- Trazodone (50-200mg at bedtime) may improve sleep quality without suppressing REM sleep Sleep hygiene practices are also important, including:
- Maintaining a consistent sleep schedule
- Creating a calm bedroom environment
- Avoiding caffeine and alcohol before bed
- Practicing relaxation techniques like deep breathing or meditation If night terrors persist despite these interventions, consulting a sleep specialist or psychiatrist for personalized treatment is recommended. It is essential to note that the efficacy of prazosin in treating PTSD-associated nightmares has been demonstrated in several studies, but a recent publication has led to a downgrade in the recommendation for its use due to contradictory findings 1. However, many patients respond well to prazosin, and it remains a viable option for pharmacologic therapy, as acknowledged by the American Academy of Sleep Medicine position paper 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Night Terrors in Adults with PTSD
- Night terrors in adults with PTSD can be triggered by a variety of traumatic events, with lifetime prevalence rates ranging from 1.3% to 10.4% 2
- The pathophysiology of nightmares in PTSD exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in nor-adrenergic, dopaminergic, and serotonin pathways 3
Treatment of Night Terrors in Adults with PTSD
- Selective serotonin reuptake inhibitors (SSRIs) can be recommended as a first-line medication for the treatment of PTSD, including night terrors 2, 4
- The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting 3
- Pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, have shown some efficacy in alleviating nightmares in subjects with PTSD, but methodological limitations and absence of large randomized controlled trials undermine the evidence 3
- Trauma-focused psychotherapies, such as cognitive behavioral therapy, prolonged exposure, cognitive therapy, cognitive processing therapy, or eye movement desensitization and reprocessing, may be as effective as SSRIs in reducing PTSD symptoms, including night terrors, but the evidence is insufficient to determine which approach is more effective 5